A total of 1.922 patients from the cardiothoracic and vascular surgical operating rooms required postoperative intensive care.

376 intensive care patients (about 20%) were treated at the ICU-13B2 (cardiosurgical intensive care unit) and 527 intensive care patients (about 30%) at the recovery-room-1 (Recovery-Room-Intensive-Care-Area, "heart positions"). The ICU-13B2 and the PACU (Post Anaesthesia Care Unit ) constitute the intensive care domain of our department.

Nevertheless, 1019 intensive care patients (about 50%) had to be treated at different other intensive care units of the General Hospital ("Other ICUs"). The treatment there was equally adequate, but did not fulfill the criteria of quality management which provide, that anaesthesia ("intensive therapy in the operating room") and subsequent intensive care might be carried out by the same team.

Intensive Care Unit 13B2

In 1997, the overall extent of utilization of beds (occupied beds / disposable beds) (blue bars) of the ICU 13B2 was between 88 and 102% (mean 98.0%), which means, that 98.0% (!) of beds that could be occupied were actually occupied! (midnight-status). The lowest figure of 88% applies to a two-week closure of the ICU for service, while the highest figure of 102% corresponds to over-occupation in emergencies! Compared with the extent of utilization in 1995, which was 95.4% (see performance report 1995), this amounts to an effective increase of more than 2.5%.

However, when the number of actually occupied beds (midnight status) is compared, not to the beds that could be occupied, but to the number of total systemized beds (beds that could be occupied + closed beds) (gray bars), then this calculation of utilization produces a mean of only 87.3%.

The overall extent of utilization (multiple occupied beds / disposable beds) (hatched bars) expresses all patients admitted to the ICU on a single day, i.e. single- or multiple-occupied beds in relation to disposable beds. This extent of utilization was 107-117% (mean 111.7%), which means, that beyond the full extent of utilization in 11.7% more than one patient per bed per day were treated.

In the entire year 1997 the number of beds that could be occupied was 2585, which represents in relation to the total number of beds (8x365=2920) a percentage of 88.5%.

This calculation emphasizes the high degree of availability and the actual occupation of beds that could be occupied, in spite of restrictions due to deficient nursing personnel. This entails a high degree of specific expended labor due to the laborious admission- and transfer-modalities (reequipment of intensive care positions, etc.). Thus, the ICU 13B2 is obviously the most extensively utilized intensive care unit of the General Hospital.

Post Anaesthesia Care Unit (PACU)
Recovery Room Intensive Care Area ("Heart positions")

In 1992, the Expert's Commission decided to establish 6 beds in the recovery-room1 (level 09) for intensive care of heart patients round the clock ("heart positions"). This step was taken because of the apparent deficiency of intensive beds for cardiac surgery patients.

The current status at this PACU (Post-Anaesthesia-Care-Unit = Recovery-Room-Intensive-Care-Area) is a 24-hour service, in terms of complete intensive care, for 4 beds on 3 days of the week. Thus, a further 527 intensive patients (about 30%) from the cardiothoracic and vascular surgical operating rooms were cared for at the PACU (and thus in our own area), in addition to the intensive patients at the ICU 13B2. From the perspective of quality assurance, this was of great importance, because it signified a more extensive fulfillment of the intensive medical principle of continuous treatment from the operating room to the intensive care unit by the same team.

In 1997, the extent of bed utilization in the recovery room1 (PACU) (occupied beds/ disposable beds) (blue bars) ranged from 85 to 116% (mean 97.5%), which means that 97.5% (!) of beds that could be occupied were actually occupied! (midnight-status). Thus, the intensive care area, recovery room 1 (PACU) had practically the same extent of utilization as did the ICU 13B2. In fact, closed beds often had to be additionally occupied in emergencies (i.e. utilizations more than 100%).

Grouping of Intensive Patients at the ICU-13B2

	CABG	Coronary artery bypass grafting blue: CABG with veins and internal mammarian artery (IMA) hatched: CABG exclusively with internal mammarian artery dotted: TMR (Transmyocardial Laser Revascularisation)
	C+V	Combined CABG- and Valve-Operations
	VAL	Single- and Multiple-Valve-Replacements (hatched)
	TAA	Thoracic Aortic-Aneurysms (blue)
	DH	DHCA (Deep Hypothermic Circulatory Arrest) (hatched) TAA- Operations in deep Hypothermia (20°C) and total Circulatory Arrest
	AAA	Abdominal Aortic-Aneurysms (hatched)
	HTX	Heart-Transplantations
	VAD	LVAD = left ventricular assist device Mechanical Left-Heart-Support
	LTX	Lung-Transplantations
	PTEA	Pulmonary Thromb-Endarterectomies
	LUNG	Lobectomies, Pneumonectomies
	LVR	Lung-Volume-Reductions-Surgery (blue)
	RES	Other thoracic Resections (hatched)
	BIF	Bifurcation-Graft (blue)
	BP	Bypassoperations of lower limbs (hatched)
	CAROTIS	Carotid artery operations
	OTHER	Other Thoracic- and Vascular-Operations

 

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Number of intensive patients and days of care at the ICU 13B2

Intensive Care Unit 13B2 (1997)

Number of intensive patients, grouped according to their duration of stay.
Most patients (96 pat.) were admitted to the intensive care unit for 2 days. That means, that the ICU-13B2 is trying its best to achieve the required minimization of stay in the ICU.

 

Number of days of care as product of the number of patients and their corresponding duration of stay in the ICU.
It is obvious that those 96 and 69 patients who were admitted to the ICU for 2 and 3 days, respectively, (see figure above) require the same number of days of care (each about 200) (see figure below), as do those 3 and 2 patients who spent 100 and > 100 days at the ICU.

 

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Automatic Registration of Medical Performances at the
ICU-13B2 and the PACU (Recovery Room Intensive Care Area)

For 1997, a detailed documentation of medical performances had to be carried out for each intensive patient. At the cardiosurgical intensive care unit 13B2, the data obtained from the patient data management system PICIS could be used.

As the data once registered by the PDM-System are archived permanently, the program modules developed at the ‘Research Institution for Intensive Therapy’ made it possible, to automatically obtain, analyze and in part correct the relevant data from the data-base of the PDM-System for the purpose of documenting the medical performances.

In order to eliminate occasional errors in automatic documentation, an overview list was created prior to the final print-out. Using this list, the staff members of the intensive care unit reviewed, within a short time, the automatically calculated results for the whole of 1997. While doing so, special attention was given to remarkable performance values (i.e. in patients with a long duration of stay). The error rate registered thereby was less than 3%; the effort of staff members of the intensive care unit was practically negligible when compared with manual documentation.

The most important Medical Performances (see next page) which were listed by an automatic search of all patient data of the PDM-System comprised the number of ventilation days, the days of hemofiltration, the number of days with an intraaortic balloon pump, as well as the number of temporary pacemakers and red-cell-concentrates.

The results were entered into a data-base and were printed for all patients in a corresponding documentation list. The relevant data of patients from the recovery room 1 (PACU - Post Anaesthesia Care Unit) in the operation wing II could be automatically taken over and printed from the performance documentation system of the department.

 

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Automatically recorded Medical Performances
at the Intensive Care Unit 13B2

 

	HTX	Heart-Transplantations
	LTX	Lung-Transplantations
	IABP	Intra-Aortic Balloon Pump
	LVAD	Left ventricular assist device Mechanical Left-Heart-Support
	RVAD	Right ventricular assist device
	Novacor	Implantable LVAD
	BIVAD	Bi-ventricular mechanical Heart-Support (Centrifugal Pump)
	Thoratec	Pulsatile BIVAD